MEDICARE: MR. RALPH JAY SKITT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2024028012	MO

General Provider Information

NPI Number	:	1639866502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH JAY SKITT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 959354
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-2741
Country	:	US
Telephone Number	:	636-695-0400
Fax Number	:	816-235-5187

Provider Business Practice Location Address
First Line	:	2299 TECHNOLOGY DR STE 130
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-7342
Country	:	US
Telephone Number	:	636-695-0400
Fax Number	:	636-916-9456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	03/10/2026

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